Organization
GENESEE VASCULAR LABORATORY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS E PENN M.D. (OWNER)
(585) 454-6610
Entity
Organization
Contact information
Practice address
919 WESTFALL RD, STE B100, ROCHESTER, NY 14618-2628
(585) 454-6610
(585) 454-6564
Mailing address
919 WESTFALL RD, STE B100, ROCHESTER, NY 14618-2628
(585) 454-6610
(585) 454-6564
Taxonomy
Speciality
Code
Description
License number
State
246Z00000X
Other Specialist/Technologist
Primary
116335
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00446337
—
NY
05
—
03158289
—
NY
Enumeration date
05/23/2005
Last updated
05/03/2012
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